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We describe a new double-bundle reconstruction method for ruptured anterior cruciate ligament using a posteromedial portal technique. Reconstruction materials are semitendinosus tendon (STT) and gracilis tendon (GT). STT is used as the substitute for the anteromedial bundle (AMB) and fixed to the tunnels produced on the tibia and the femur. GT is used as the substitute for the posterolateral bundle (PLB) and fixed to the tunnels on the tibia and the femur. This femoral tunnel for the PLB is created through a posteromedial portal. These procedures are performed using the inside-out technique. The posteromedial portal provides an accurate access to the femoral attachment of the PLB. This surgical technique can avoid overlapping of the 2 femoral tunnels and destruction of the posterior cortex of the lateral condyle on the femur during the preparation of the PLB. Our technique does not need another tibial tunnel for the PLB; the 1 tibial tunnel enables double-bundle reconstruction and prevents tibial tunnel expansion.

Purpose: Balancing the gap is essential in total knee arthroplasty (TKA). The purpose of this study was to quantify the influence of patellar position on femoro-tibial joint load in TKA. We hypothesized that resetting of the patella increased medial joint load and decreased lateral joint load. Methods: Our original tensor system was used during posterior-stabilized (PS) and cruciate-retaining (CR) total knee arthroplasty (TKA) using medial para-patellar approach (MPP) or sub-vastus approach (SV). Results: In PS-TKA, by resetting the patella, the ratios between medial and lateral compartments were not changed in both extension and flexion position using MPP and were significantly changed in flexion position using SV. In CR-TKA, by resetting the patella, the load of the lateral component decreased and the ratios between medial and lateral compartments were changed significantly in both extension and flexion position using SV. Conclusion: It is important to be aware that, when performing CR-KA, the load of the lateral compartment will decrease by resetting the patella using SV. Level of evidence: Therapeutic studies investigating the results of treatment, Level II. [ABSTRACT FROM AUTHOR]